Gliederung

Objective

Vitrectomy and peeling of the internal limiting membrane (ILM) is a common procedure in the sugical treatment of full-thickness macular holes. Disclosure of macular holes after surgery seldem leeds to spontaneous closure and return of visual function after months.

Methods

This case shows a spontaneous closure of macular hole after unsuccessful surgical treatment by peeling the internal limiting membrane. For documentation of the ongoing readaptation of the retina we used fundus photography, fluorescein angiography and optical coherence tomography (OCT).

Results

Vitrectomy and ILM-peeling without intraoperative use of ICG was done in a 67-year-old man with a full-thickness macular hole (stage III in OCT). Three weeks after resorption of the intraocular gas the macular hole was still present in funduscopy and OCT and the visual acuity was 0.2. Six weeks later a connecting membrane was shows above the hole. Another three months later the hole was closed and showed a subfoveal lumen in the OCT (visual acuity 0.4). After six months a regular foveal depression in the OCT an a visual acuity of 0.8 was found.

Conclusions

Even some months after surgical treatment spontaneous closure of macular holes can be obtained. This case shows the mechanism of in vivo closure of a macular hole. Even longer times after vitrectomy closure of macular holes can be seen in rare cases.